GOVARESH JOURNAL
Year:2011 | Volume:15 | Issue:4 (73)|Papers Count:10

Background: The current immunosuppressive treatment of patients with autoimmune hepatitis (AIH) consists of prednisolone and azathioprine. High doses of prednisolone used for disease remission are not universally effective and have serious adverse effects. Some authors have provided evidence of AIH therapy in children and adults with cyclosporine (Neoral) should corticosteroid therapy become ineffective. Preliminary results using cyclosporine in a small group of patients have shown that this drug appears to be a good substitute for corticosteroids. We performed this study to assess the efficacy and safety of cyclosporine in induction of remission in children with AIH.Methods: This was a case series, interventional clinical trial that involved children with AIH. twelve children with a median age of 9 years, 3 months who were diagnosed according to international criteria as having definite AIH were recruited. Cyclosporine alone was administered at a dosage of 3.5-5 mg/kg in 3 daily doses for 5 months, followed by low dose prednisolone (0.3 mg/kg/d) for one month, then followed by combined low doses of prednisolone and azathioprine (1.5 mg/kg/d in two doses). Patients discontinued cyclosporine after seven months. Biochemical remission of the disease was established by assessment of serum transaminase activity levels. Growth parameters that included Z-scores for height and weight, and adverse effects of the treatment were recorded.Results: Of the 10 remaining patients, 7 had normalized alanine aminotransferase (ALT) activity levels by 4 months and all patients had normalized ALT levels by 9 months of treatment. Adverse effects of cyclosporine were mild and disappeared during weaning off the medication.Conclusion: Cyclosporine induced biochemical remission of the hepatic inflammatory/necrotic process in children with AIH.There were few, well–tolerated adverse effects. Longer follow-up of patients is necessary to establish possible long-term toxicity of cyclosporine.

Background: Colorectal cancer (CRC) is one of the most common invasive cancers responsible for physical and psychosocial morbidity. Therefore, quality of life (QoL) is an important outcome for these patients. Despite advances in understanding QoL, the majority of available research is from urban areas. The present study aims to compare QoL between urban and rural CRC patients.Materials and Methods: In this cross-sectional study, we assessed 110 patients with CRC (79 urban, 31 rural) who referred to Razi Hospital. Demographic and clinical factors were collected by data collection forms, and through patient interviews and review of medical records. Specific QoL was evaluated by FACT-C. Data was analyzed by SPSS version 16, t- and chi-square tests.Results: Mean scores for specific QoL were higher in urban patients than those who resided in rural areas (p<0.05), this difference was statistically significant in the domains of physical wellbeing (p<0.02) and functional wellbeing (p<0.01). Only in the mean scores of social and family wellbeing were rural patients partially higher than urban patients, but this difference was not statistically significant.Conclusion: Specific QoL of patients with CRC differs according to residence location. QoL is higher for those who reside in urban areas in comparison with rural areas. This highlights the need for interventions in the performance of health and QoL promotion amongst rural patients.

Background: Juxta-ampullary diverticulum is an acquisitive disorder generally observed in patients over the age of forty years. The purpose of this study is to evaluate the relationship between this abnormality and the incidence of post-ERCP complications.Materials and Methods: This was a case-control cross-sectional study that compared post- ERCP complications between patients with juxta-ampullary diverticula and those with no juxta-ampullary diverticula. We classified diverticula based on anatomic locations with respect to the ampulla.Results: A total of 718 patients referred to our endoscopic ward during one year for ERCP. From these cases, 685 patients underwent ERCP. A total of 47 (6.9%) patients had juxta-ampullary diverticuli, which consisted of type A (25.5%), type B (46.8%), type C (12.8%) and type D (14.9%). The frequency of CBD stones and cholangitis in the case group was significantly more than the control group (p<0.001). The mean age of patients in the case group was ten years older than patients in the control group (68.04±15.02 vs.58.25±17.48), which was significant (p<0.001).Conclusion: There is an association between juxta-ampullary diverticula and the frequency of CBD stones and post-ERCP complications.

Background: Maintenance of health and its fair and just promotion in any society is the responsibility and duty of its respective government. Appropriate financial allocations and prudent decisions in the health sector requires the definition of an index that would reveal the loss resulting from early deaths of any cause and originate from disabilities due to nonfatal outcomes.The disability adjusted life years (DALY) index has such a characteristic. Esophageal cancer is the third prevalent cancer of the gastrointestinal tract. In Golestan Province, among the variety of cancers, it is the third leading cause of death and its incidence rate in the province is the highest in the country. In this study we try to compute the burden of this cancer. In this manner, while estimating the importance of this disease in Golestan Province, we aim to pave the way for scientific and effective assessments of this disease and determine an action plan for its containment.Materials and Methods: In this cross-sectional study, we used Dismod II software that has been designed for cancer modeling in populations. With this software, we computed the burden of cancer for the year 1387 in Golestan Province. The data needed as input for Dismod II included the population of the province, mortality and incidence rates that originated from esophageal cancer, all which were obtained from the 1385 census, Mortality Registry System, Cancer Registry System and expert panel views.Results: Total burden of esophageal cancer according to DALY in Golestan Province during 1387 was 2992.48 years in the total population. Amongst males, it was 1533.65 years and 1408.46 years in females due to years of lost life (YLL). As a result of years lived with disability (YLD), it was 25.54 years in males and 24.84 years in females.The burden of esophageal cancer per 1000 population of Golestan Province equaled 1.76 years for females and 1.88 years for males.The peak age of esophageal cancer burden was in the age groups of 60 to 80 years and above 80 years.Conclusion: The relative high burden of esophageal cancer in Golestan Province compared to other parts of the country is justifiable due to the existence of the highest incidence rate in this province. Therefore, we believe that esophageal cancer should be one of the highest priorities of the health system of the province. However, the final and definitive judgment is contingent upon computations of the burden of other cancers and diseases at the provincial level and its respective rankings.

Background: There is a relationship between specific genotypes of Helicobacter pylori cagA and vacA genes and the increased risk of peptic ulcer diseases and gastric cancer. These genes also possess strong patterns of geographical differentiation. The present study aims to determine the patterns of variation of the virulence genes in Iran and their association with clinical status. Materials and Methods: Sequence fragments for cagA and vacA were obtained from a total of 147 H. pylori isolates from diverse geographical and ethnic sources within Iran. We used phylogenetic methods to determine the patterns of allelic diversity, and the relationship between evolutionary lineages and clinical status. Results: Phylogenetic analyses of Iranian cagA gene disclosed four lineages, whereas the vacA gene had two distinct lineages. The cagA lineage II showed extensive genetic diversity compared with lineage I. cagA lineages III and IV disclosed mixed ancestries with recombinant nucleotides that originated from lineages I and II. Iranian strains with vacA lineage II genotype were significantly cagA+ (>90%, p=0.0) and correlated with a higher rate of peptic ulcers in infected individuals (p=0.003). Most strains in the cagA lineage I showed a vacA lineage II genotype (p=0.003) and significantly correlated with an increased risk of peptic ulcers in infected individuals (p=0.022). Strains with cagA lineage III genotype significantly correlated with gastritis (p=0.0). Conclusion: The increased level of allelic diversity in the virulence genes shows strong evolutionary dynamics, resulting in the emergence of new clonal genealogies of the cagA gene within Iran. Particular lineages of the Iranian cagA and vacA genes correlate with peptic ulcer diseases.

The incidence of drug induced liver injury (DILI) is about 1.1000 to 1.10000 among patients who receive therapeutic drug doses. Drug induced hepatotoxicity is a major cause of acute and chronic liver disease. The severity of liver damage ranges from nonspecific changes in liver structure to acute liver failure, cirrhosis and liver cancer. Some common agents that can cause liver injury are acetaminophen, antibiotics, statins, INH and herbal drugs. Drug-induced hepatotoxicity can be categorized based on the pattern of liver enzyme alteration (hepatocellular, cholestatic or mixed pattern), the mechanism of hepatotoxicity (direct, immune mediated or idiosyncratic) and histologic findings on liver biopsy (steatosis or sinusoidal obstruction syndrome). Treatment options for DILI include discontinuing the drug, conservative measurements and liver transplantation in the case of non-acetaminophen induced hepatotoxicity.

Celiac disease is a gluten–related malabsorption in the small intestine that occurs in genetically susceptible patients. In this disease the risk of many malignancies is increased, of which the most important is non-Hodgkin lymphoma of the small intestine. Other malignancies include adenocarcinoma of the small intestine and squamous cell carcinoma of the esophagus. To the best of our knowledge, thus far only one case of celiac disease associated with hypopharyngeal squamous cell carcinoma has been reported. Herein, we present the case of a patient with celiac disease diagnosed with squamous cell carcinoma of the hypopharynx. She underwent chemo- and radiation therapy treatments, Unfortunately, she died because of disease progression. In patients with celiac disease we should pay attention to the possibility of various malignancies. When cancer patients have malabsorption we must consider the possibility of celiac disease involvement.